My entire professional career, spanning nearly four decades, has been in cancer care. On 12 August 2022, at the age of 64, I was myself diagnosed with mantle cell lymphoma, a rare and aggressive type of cancer that affects the immune system and has a very poor prognosis – I was told that survival without treatment would be only eight weeks.
I was fortunate to have access to Australia’s world-class care. I received chemotherapy and a stem cell transplant, and by World Cancer Day in February 2024, I was in remission.
As for so many cancer patients, daily medications and monthly infusions are now a necessary part of life, and the side effects of treatment are considerable: fatigue; brain fog; loss or changes to taste, smell and other senses; oedema of the eye lining; temperature regulation issues (cold sensitivity due to neuropathy); and loss of appetite.
Among the more serious, however, is a severely weakened immune system, which makes it harder to fight off infections. Last summer I caught an infection caused by a strain of bacteria that has proved resistant to multiple antibiotics.
My experience with antimicrobial resistance (AMR) is not a unique situation. It is, tragically, for so many, becoming more and more common.
AMR is the ability of bacteria, fungi, viruses and parasites to evolve and survive the effects of antimicrobials (antibiotics, antifungals, antivirals and antiparasitics) that are designed to kill them. This makes it much harder to treat the infections that these microorganisms cause, and the infections are then also more likely to spread.
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A common condition
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The human toll of non-communicable diseases (NCDs) is huge and rising. These illnesses end the lives of approximately 41 million of the 56 million people who die every year – and three quarters of them are in the developing world.
NCDs are simply that; unlike, say, a virus, you can’t catch them. Instead, they are caused by a combination of genetic, physiological, environmental and behavioural factors. The main types are cancers, chronic respiratory illnesses, diabetes and cardiovascular disease – heart attacks and stroke. Approximately 80% are preventable, and all are on the rise, spreading inexorably around the world as ageing populations and lifestyles pushed by economic growth and urbanisation make being unhealthy a global phenomenon.
NCDs, once seen as illnesses of the wealthy, now have a grip on the poor. Disease, disability and death are perfectly designed to create and widen inequality – and being poor makes it less likely you will be diagnosed accurately or treated.
Investment in tackling these common and chronic conditions that kill 71% of us is incredibly low, while the cost to families, economies and communities is staggeringly high.
In low-income countries NCDs – typically slow and debilitating illnesses – are seeing a fraction of the money needed being invested or donated. Attention remains focused on the threats from communicable diseases, yet cancer death rates have long sped past the death toll from malaria, TB and HIV/Aids combined.
‘A common condition’ is a Guardian series reporting on NCDs in the developing world: their prevalence, the solutions, the causes and consequences, telling the stories of people living with these illnesses.
Tracy McVeigh, editor
As many as one in five cancer patients are hospitalised because of infection, relying on antibiotics as their main line of defence. If they do not work and the infection becomes difficult to treat, surgeries and organ transplants become more complicated, treatment may be delayed, and the patient may need to be placed in intensive care for an extended period, further increasing healthcare costs.
Ultimately, the person could die from the infection – when their cancer was curable.
Cancer remains the second leading cause of death worldwide, with 20 million new cases and nearly 10 million deaths in 2022. While this is expected to increase in coming years as a result of ageing populations, lifestyle changes and other factors – notably in low- and middle-income countries – we have seen incredible progress in recent decades in cancer detection and treatment.
With routine screening programmes and advances in technology, we are able to detect cancers at much earlier stages, even pre-cancerous, when they are much easier to treat successfully. Similar advances in radiotherapies and chemotherapies have made treatments less invasive and more effective. And a better understanding of cancer and our immune systems have led to innovative, targeted treatments – precision medicine, immunotherapy – that are further improving people’s chances of survival, even at more advanced stages.
For this reason, most high-income countries, where these technologies are available and accessible, have seen cancer-related deaths drop by up to 30% since the 1990s. And even greater progress is visible on the horizon, thanks to artificial intelligence, mRNA cancer vaccines, and the prospect of detecting several cancers at the same time with a single blood test.
AMR threatens to seriously undermine this incredible success in treating cancer. For this reason, the Union for International Cancer Control (UICC) has been actively engaging its members around the world in the global response to the problem.
The World Health Organization (WHO) says AMR is one of the top 10 global health and development threats facing humanity today. AMR was associated with 4.95 million deaths in 2019 and a reported 1.27 million people died as a direct result of drug-resistant infections. This number could reach 10 million by 2050 without collective action, with AMR costing a cumulative $100tn (£78tn) of economic output by 2050.
Together with cancer, AMR requires urgent and coordinated responses from all stakeholders, including governments, health professionals, researchers, civil society, industry, people living with cancer and their families. AMR is a cross-cutting issue, which requires a multisectoral and multidisciplinary approach based on the “one health” concept of the interconnection of human, animal and environmental health.
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First, prevention: implementing effective infection prevention and control measures, such as maintaining hygiene and sanitation standards, can reduce the spread of resistant infections.
We also need urgently to address misuse and overuse. This happens in medical settings when antibiotics are prescribed unnecessarily, such as for viral infections, or when they are used for longer than necessary. Education on the appropriate use and disposal of these medications is also crucial for healthcare providers and patients.
Another example is in agriculture, where antibiotics are often used to promote growth and prevent disease in livestock.
To avoid drugs developing a resistance, we need better stewardship and strict guidelines for prescribing, dispensing and administering antibiotics in all settings. Surveillance systems are also essential for monitoring antibiotic use and resistance patterns, facilitating data-driven policy decisions.
Finally, because antibiotics and other antimicrobials are designed to be used as little as possible, we need to find new financing models, such as the UK subscription model, to increase investment in research and development to discover new antibiotics and alternative treatments.
Complacency is not an option. We must act decisively to keep antimicrobial resistance at bay and continue advancing the lifesaving therapies that give hope to cancer patients like me.
And I consider myself one of the lucky ones. While I am in remission, the cancer will come back, and I will have access to second-line treatment and, if I go again into remission and when the cancer returns again, third-line treatment of the very new CAR-T therapy.
This experience has provided me with a deeply personal perspective on the importance of research, and making these treatments and infection control available to all.
